Abstract
Background: The author recently reported ∼50% excess early mortality in patients with first-presentation ST-segment elevation myocardial infarction (STEMI) without standard modifiable cardiovascular risk factors (SMuRFs); the cause of this is not clear. Objectives: The aim of this study was to examine differences in infarct characteristics and clinical outcomes in patients with versus without SMuRFs (dyslipidemia, hypertension, diabetes mellitus, and smoking). Methods: Individual-level data were pooled from 10 randomized percutaneous intervention (PCI) trials in which infarct size was measured within 1 month by either cardiac magnetic resonance or technetium-99m sestamibi single-photon emission computed tomography imaging. First-presentation STEMI was classified into 2 groups according to the presence or absence of at least 1 SMuRF. Results: Among 2,862 patients, 524 (18.3%) were SMuRF-less. After adjusting for study effect, SMuRF-less patients had more frequent poor pre-PCI flow Thrombolysis In Myocardial Infarction 0/1 compared with patients with at least 1 SMuRF (72.0% vs 64.1%; OR: 1.35; 95% CI: 1.08-1.70). There were no independent associations between the presence or absence of SMuRFs at baseline and infarct size (estimate = −0.35; 95% CI: −1.93 to 1.23), left ventricular ejection fraction (estimate = −0.06; 95% CI: −1.33 to 1.20), or mortality at 30 days (HR: 0.46; 95% CI: 0.19-1.07) and 1 year (HR: 0.74; 95% CI: 0.43-1.29). Conclusions: First-presentation STEMI patients with no identifiable baseline SMuRFs had a higher risk of Thrombolysis In Myocardial Infarction flow grade 0/1 pre-PCI. However, after adjustment, there were no significant associations between SMuRF-less status and infarct size, left ventricle ejection fraction, or mortality.
| Original language | English |
|---|---|
| Journal | JACC: Cardiovascular Interventions |
| Volume | 15 |
| Issue number | 11 |
| Pages (from-to) | 1167-1175 |
| Number of pages | 9 |
| ISSN | 1936-8798 |
| DOIs | |
| Publication status | Published - 13.06.2022 |
Funding
Dr Figtree is supported by a National Health and Medical Research Council Practitioner Fellowship (grant number APP11359290), Heart Research Australia, and the New South Wales Office of Health and Medical Research. Prof Grieve is supported by the Parker-Hughes Bequest, the New South Wales Office of Health and Medical Research, and the Frecker Family. Dr Figtree has received funding from National Health and Medical Research Council (Australia) Practitioner Fellowship and New South Wales Office of Health and Medical Research (Senior Investigator grant). Dr Patel has received research grants from Bayer, Janssen, HeartFlow, National Heart, Lung, and Blood Institute; and has received advisory board/consulting fees from AstraZeneca, Bayer, Janssen, and HeartFlow. Dr Udelson has served on trial steering committees for Abiomed; and has served as a consultant for Imbria Pharmaceuticals. Dr Ohman has received research grants from Abiomed, Chiesi, and Portola, and consulting fees from Abiomed, Cara Therapeutics, Genentech, Imbria Pharmaceuticals, Impulse Dynamics, Janssen Pharmaceuticals, Medtronic, Medscape, Milestone Pharmaceuticals, and XyloCor Therapeutics. Dr Maehara has received grant support and consulting fees from Abbott Vascular and Boston Scientific. Dr Karmpaliotis has received honoraria from Abbott Vascular and Boston Scientific; and holds equity in Saranas, Soundbite, and Traverse Vascular. Dr Granger has received research grants from AstraZeneca, Food and Drug Administration, National Institutes of Health, GlaxoSmithKline, Medtronic, Novartis, Apple, Boehringer Ingelheim, BMS/Pfizer, and Janssen; and has received consulting fees from AstraZeneca, Espero, GlaxoSmithKline, Medtronic, Novartis, Boehringer Ingelheim, Boston Scientific, BMS/Pfizer, Daiichi-Sankyo, Merck, Roche, Eli Lilly, and Janssen. Dr Stone has received grants or contracts from Abbott (institutional); has received consulting fees from Valfix, TherOx, Robocath, HeartFlow, Ablative Solutions, Vectorious, Miracor, Neovasc, Abiomed, Ancora, Elucid Bio, Occlutech, CorFlow, Apollo Therapeutics, Impulse Dynamics, Reva, Shockwave, V-Wave, Cardiomech, Gore, Vascular Dynamics; has received honoraria from Cook and Infraredx; and holds stock (equity) in Ancora, Cagent, Applied Therapeutics, Biostar Family of Funds, Spectra Wave, Orchestra Biomed, Aria, Cardiac Success, Valfix, and MedFocus Family of Funds. Dr Kosmidou has received research grant support from Amgen and advisory board/consulting fees from Sanofi. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Research Areas and Centers
- Centers: Cardiological Center Luebeck (UHZL)
DFG Research Classification Scheme
- 2.22-12 Cardiology, Angiology
